Logic and Logistics of Monitoring Large Bowel Cancer

  • Edward H. Cooper
  • A. Munro Neville
Part of the Sloan-Kettering Institute Cancer Series book series (SKICS)


There is still a general dissatisfaction with the results of surgery for the treatment of large bowel cancer; the overall 5-year survival rate for resectable tumors is approximately 40% (Rhoads, 1975; Silverberg and Hollet, 1974). This survival rate has remained static for many years in major hospitals with extensive experience in this disease. Chemotherapy has had a limited success so far; many adenocarcinomas of the bowel have been shown to be relatively resistant to the drugs available, although short-term palliation is not too difficult to obtain, the more recent forms of combination chemotherapy perhaps giving ground for cautious optimism (Carter, 1976). Nevertheless, it looks as if for the next few years we must place our hopes in chemotherapy to aid surgery. The problem then is to find the right combination of drugs, dose, and timing to suit the individual patient and his particular tumor. Current knowledge suggests that chemotherapy will have the best chance of being effective when the tumor load is small. This in turn has created a greater demand for aids to identify patients with a high risk of recurrence after surgery and systems to monitor the patient after excision of a primary tumor of the large bowel, as well as helping to assess the response of a tumor to therapy.


Colorectal Cancer Rectal Cancer Large Bowel Hepatic Metastasis Carcinoembryonic Antigen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anderson, J. A., 1972, Separate sample logistic discrimination, Biometrika 59: 19–35.CrossRefGoogle Scholar
  2. Astler, V. B., and Coller, F. A., 1954, The prognostic significance of direct extension of carcinoma of the colon and rectum, Ann. Surg. 139: 846–852.PubMedCrossRefGoogle Scholar
  3. Bacchus, H., 1975, Serum glycoproteins in cancer, Progr. Clin. Pathol. 6: 111–135.Google Scholar
  4. Baden, H., Anderson, B., Augustenborg, G., and Hanel, H. K., 1971, Diagnostic value of γ glutamyl transpeptidase and alkaline phosphatase in liver metastases, Surg. Gynal. Obstet 133: 769–773.Google Scholar
  5. Bagshawe, K. D., Rogers, G. T., Searle, F., and Wilson, H., 1973, Blood carcinoembryonic antigen Regan Isoenzyme and human chorionic gonadotrophin in primary mediastinal carcinoma, Lancet 1: 210–211.PubMedCrossRefGoogle Scholar
  6. Bengmark, S., and Hafström, L., 1969, The natural history of primary and secondary tumours of the liver. I Prognosis for patients with hepatic metastases from colon and rectal carcinoma by laparotomy, Cancer 23: 198–202.PubMedCrossRefGoogle Scholar
  7. Booth, S. N., Jamieson, G. C., King, J. P. G., Leonard, J. C., Oates, G. D., and Dykes, P. W., 1974a, Carcinoembryonic antigen in management of colorectal cancer, Br. Med. J. 4: 183–187.CrossRefGoogle Scholar
  8. Booth, S. N., King, J. P. G., Leonard, J. C., and Dykes, P. W., 1974b, The significance of elevation of serum carcinoembryonic antigen (CEA) levels in inflammatory disease of the intestine, Scand. J. Gastroenterol. 9: 651–656.Google Scholar
  9. Botsford, T. W., Aliapoulios, M. R., and Fogelson, F. S., 1971, Results of treatment of colorectal cancer at the Peter Bent Brigham Hospital from 1960 to 1965, Ann. Surg. 121: 398–402.CrossRefGoogle Scholar
  10. Bullen, B. R., Cooper, E. H., Turner, R., Neville, A. M., Giles, G. R., and Hall, R., 1976, Cancer markers in patients receiving chemotherapy for colorectal cancer, A preliminary report, Med. and Ped. Oncology 3: 289–300.CrossRefGoogle Scholar
  11. Carter, S. K., 1976, Large bowel cancer—The current status of treatment, J. Natl. Cancer Inst. 56: 3–10.PubMedGoogle Scholar
  12. Cass, A. W., Million, R. R., and Pfaff, W. W., 1975, Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum, Cancer 37: 2861–2865.CrossRefGoogle Scholar
  13. Cooper, E. H., 1967, Enzymes in bladder tumors, in: Scientific Foundations of Virology ( D. I. Williams and G. D. Chisholm, eds.), pp. 322–325, Heinemann, London.Google Scholar
  14. Cooper, E. H., Turner, R., Steele, L., Neville, A. M., and Mackay, A. M., 1975, The contribution of serum enzymes and carcinoembryonic antigen to the early diagnosis of metastatic colorectal cancer, Br. J. Cancer 31: 111–117.PubMedCrossRefGoogle Scholar
  15. Cooper, E. H., Turner, R., Geekie, A., Neville, A. M., Goligher, J. C., Graham, N. G., Giles, G. R., Hall, R., and MacAdam, W. A. F., 1976a, Alpha globulins in the surveillance of colorectal cancer, Biomedicine 24: 174–178.Google Scholar
  16. Cooper, E. H., Eaves, G., Turner, R., Neville, A. M. and Ward, A. M., 1976b, Experience of multiparametric tests in the monitoring of large bowel cancer, Bull. Cancer 63: 541–550.PubMedGoogle Scholar
  17. Dale, R. A., 1965, The activities of several enzymes of mucosa, carcinomata and polyps of human colon, Clin. Chim. Acta 11: 547–556.PubMedCrossRefGoogle Scholar
  18. Double, J. A., Cooper, E. H., and Goligher, J. C., 1977, Hydrolytic enzymes in colorectal cancer, Biomedicine 27: 11–13.PubMedGoogle Scholar
  19. Dukes, C. E., 1932, The classification of cancer of the rectum, J. Pathol. Bacteriol. 35: 323–332.CrossRefGoogle Scholar
  20. Dukes, C. E., 1960, The pathology of rectal cancer, in: Cancer of the Rectum ( C. E. Dukes, ed.), pp. 59–68, Livingstone, Edinburgh.Google Scholar
  21. Egan, M. L., Lautenschleger, J. T., Coligan, J. E., and Todd, C. W., 1972, Radioimmunoassay of carcinoembryonic antigen, Immunochemistry 9: 289–299.PubMedCrossRefGoogle Scholar
  22. Fischerman, K., Patersen, C. F., Lindkaer Jensen, S., Christensen, K. Z., and Efsen, E., 1976, Survival among patients with liver metastases from cancer of the colon and rectum, Scand J . Gastroenterol. Suppl. 37: 111–115.PubMedGoogle Scholar
  23. Galen, R. S., 1975, Multiphasic screening and biochemical profiles: State of the art, Progr. Clin. Pathol. 6: 83–110.Google Scholar
  24. Gérard, A., 1975, Carcinoma of the colon and rectum: Prognostic factors in cancer therapy, in: Prognostic Factors and Criteria of Response ( M. J. Staquet, ed.), Raven Press, New York.Google Scholar
  25. Go, V. L. M., 1976, Carcinoembryonic antigen, Cancer 37: 562–566.PubMedCrossRefGoogle Scholar
  26. Gold, P., and Freedman, S. 0., 1965, Demonstration of tumor-specific antigens in human colonic carcinoma by immunological tolerance and absorption techniques, J: Exp. Med. 121: 439–462.CrossRefGoogle Scholar
  27. Goligher, J. C., 1941, The operability of carcinoma of the rectum, Br. Med. J. 2: 393–397.PubMedCrossRefGoogle Scholar
  28. Hogg, L., Jr., and Pack, G. T., 1956, Diagnostic accuracy of hepatic metastases at laparotomy, Arch. Surg. 72: 251–252.CrossRefGoogle Scholar
  29. Jaffe, B. M., Donegan, W. L., Watson, F., and Spratt, J. S., 1968, Factors influencing survival in patients with untreated hepatic metastases, Surg. Gynecol. Obstet. 127: 1–11.PubMedGoogle Scholar
  30. Khoo, S. K., and Mackay, E. V., 1973, Carcinoembryonic antigen in cancer of the female reproductive system, Aust. N.Z. J. Obstet. Gynecol. 13: 1–7.CrossRefGoogle Scholar
  31. Kim, U. S., Papatestas, A. E., and Aufses, A. H., 1976, Prognostic significance of peripheral lymphocyte counts and carcinoembryonic antigens in colorectal carcinoma, J. Surg. Oncol. 8: 257–262.PubMedCrossRefGoogle Scholar
  32. Kirklin, J. W., Dockerty, M. D., and Waugh, J. W., 1949, The role of peritoneal reflection in the prognosis of carcinoma of the rectum and sigmoid colon, Surg. Gynecol. Obstet. 88: 326–331.PubMedGoogle Scholar
  33. Koj, A., 1975, Acute phase reactants, in: Structure and Function of Plasma Proteins, Vol. I ( A. C. Allison, ed.), pp. 73–132, Plenum, New York.Google Scholar
  34. Langvad, E., and Jemec, B., 1975, Prediction of local recurrence in colorectal carcinoma: An LDH isoenzymatic assay, Brt J . Cancer 31: 661–664.CrossRefGoogle Scholar
  35. Laurence, D. J., and Neville, A. M., 1972, Foetal antigens and their role in the diagnosis and clinical management of human neoplasm: A review, Br. J. Cancer 26: 335–355.PubMedCrossRefGoogle Scholar
  36. Laurence, D. R. J., Stevens, U., Bettelhiem, R., Darcy, D., Leesen, C., Tuberville, Co., Alexander, P., Jones, E. W., and Neville, A. M., 1972, Role of carcinoembryonic antigen, Br. J. Med. 3: 605–609.CrossRefGoogle Scholar
  37. LoGerfo, P., and Herter, F. P., 1975, Carcinoembryonic antigen and prognosis in patients with colon cancer, Ann. Surg. 181: 81–83.CrossRefGoogle Scholar
  38. Mach, J. P., Jaeger, P., Bertholet, M. M., Ruegsegger, C. H., Loosli, R. M., and Pettavel, J., 1974, Detection of recurrence of large bowel carcinoma by radioimmunoassay of circulating carcinoembryonic antigen (CEA), Lancet 2: 535–540.PubMedCrossRefGoogle Scholar
  39. Mackay, A. M., Patel, S., Carter, S., Stevens, U., Laurence, D. J. R., Cooper, E. H., and Neville, A. M., 1974, Role of serial plasma CEA assays in detection of recurrent and metastatic colorectal carcinomas, Br. J. Med. 4: 382–385.CrossRefGoogle Scholar
  40. Marner, I. L., Friborg, S., and Simonsen, E., 1975, Disease activity and serum proteins in ulcerative colitis: Immunochemical quantitation, Scand. J. Gastroenterol. 10: 537–544.PubMedGoogle Scholar
  41. Munjal, D., Chawla, P. L., Lokich, J. J., and Zamcheck, N., 1976, Carcinoembryonic antigen and phosphohexose isomerase, gamma glutamyl transpeptidase and lactate dehydrogenase levels in patients with and without liver metastases, Cancer 37: 1800–1807.PubMedCrossRefGoogle Scholar
  42. Neville, A. M., and Cooper, E. H., 1976, Biochemical monitoring of cancer, Ann. Clin. Biochem. 13: 283–305.PubMedGoogle Scholar
  43. Ravry, M., Moertel, C. G., Schutt, A. J., and Go, V. L. M., 1974, Usefulness of serial serum carcinoembryonic antigen CEA determinations during anti-cancer therapy or long term follow-up of gastrointestinal carcinoma, Cancer 34: 1230–1236.PubMedCrossRefGoogle Scholar
  44. Rhoads,J.E., 1975, The control of large bowel cancer, Cancer 36:2314–2318.PubMedCrossRefGoogle Scholar
  45. Schwartz, M. K., 1975, Enzymes in colon cancer, Cancer 36: 2334–2336.PubMedCrossRefGoogle Scholar
  46. Schwartz, M. K., 1976, Laboratory aids to diagnosis—Enzymes, Cancer 37: 542–548.PubMedCrossRefGoogle Scholar
  47. Silverberg, E., and Hollet, A.I., 1974, Cancer statistics 1974—Worldwide epidemiology, Cancer 24: 1–64.Google Scholar
  48. Skarin, A. T., Delwiche, R., Zamcheck, N., Lokich, J.J., and Frei, E. III, 1974, Carcinoembryonic antigen: Clinical correlation with chemotherapy for metastatic gastrointestinal cancer, Cancer 33: 1239–1245.PubMedCrossRefGoogle Scholar
  49. Sorokin, J.J., Sugarlaker, P. H., Zamcheck, N., Pisick, M., Kupchick, H., and Moore, F. D., 1974, Serial CEA assays: Use in detection of recurrence following resection of colon cancer, J. Am. Med. Assoc. 228: 49–53.CrossRefGoogle Scholar
  50. Steele, L., Cooper, E. H., Mackay, A. M., Losowsky, M. S., and Goligher, J. C., 1974, Combination of carcinoembryonic antigen and gamma glutamyl transpeptidase in the study of the evolution of colorectal cancer, Br. J. Cancer 30: 319–324.PubMedCrossRefGoogle Scholar
  51. Turner, M. D., 1975, Carcinoembryonic antigen, J. Am. Med. Assoc. 231: 756–758.CrossRefGoogle Scholar
  52. Ward, M. A., Cooper, E. H., Turner, R., Anderson, J. A., and Neville, A. M., 1977, Acute phase reactant protein profiles: An aid to monitoring of large bowel cancer by carcinoembryonic antigen and serum enzymes, Br. J. Cancer 35: 170–178.PubMedCrossRefGoogle Scholar
  53. Whitfield, J. B.,Pounder, R. E., Neale, G., and Moss, D. W., 1972, Serum γ glutamyl transpeptidase activity in liver disease, Gut 13:702–708.PubMedCrossRefGoogle Scholar
  54. Zamcheck, N., Doos, W. G., Prudente, R., Lurie,B. B., and Gottliet, L. S., 1975, Prognostic factors in colon carcinoma: Correlation of serum carcinoembryonic antigen and tumor histopathology, Hum. Pathol. 6: 31–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1978

Authors and Affiliations

  • Edward H. Cooper
    • 1
    • 2
  • A. Munro Neville
    • 1
    • 2
  1. 1.Department of Cancer ResearchUniversity of LeedsLondonEngland
  2. 2.The Ludwig Institute for Cancer ResearchThe Royal Marsden HospitalLondonEngland

Personalised recommendations